Autologous Bone Marrow Transplant
An autologous transplant is a type of transplant that uses the person's own stem cells. These cells are collected in advance and returned at a later stage. They are used to replace stem cells that have been damaged by high doses of chemotherapy, used to treat the person's underlying disease.
When is it used?
Autologous transplants are used to treat a number of different blood cancers - leukaemias lymphomas and myeloma, and certain solid tumours – breast cancer, testicular cancer, osteosarcoma and others. Autologous transplants allow the use of high dose chemotherapy, which provides some people with a better chance of cure or long-term control of their disease.
Most people have a single autologous transplant. Others, particularly those with myeloma or some solid tumours, may have two or more sequential (one after the other) transplants, over a period of a few months.
How are the stem cells collected?
In most cases, stem cells are collected directly from the bloodstream. While stem cells normally live in your marrow, a combination of chemotherapy and a growth factor (a drug that stimulates stem cells) called Granulocyte Colony Stimulating Factor (G-CSF) is used to expand the number of stem cells in the marrow and cause them to spill out into the circulating blood. From here they can be collected from a vein by passing the blood through a special machine called a cell separator, in a process similar to dialysis. This machine separates and collects the stem cells and returns the rest of your blood to you. The stem cells are then processed, frozen and stored until the scheduled date of your transplant. This procedure is usually carried out in the outpatient department of the hospital.
In the week leading up to your transplant you will be given a few days of very high dose chemotherapy, and sometimes radiotherapy, to destroy your underlying disease. This is called conditioning therapy. After you have finished this treatment, your stem cells are thawed and reinfused through a vein into your blood stream. This is similar to a blood transfusion. From here, the stem cells make their way to your bone marrow where they become re-established and start making new blood cells.
After the transplant
Your blood counts drop dramatically in the week following your conditioning therapy. This is normal. During this time you will be more at risk of infections (due to the lack of infection-fighting white blood cells) and bleeding (due to a lack of platelets). Antibiotics and other drugs are commonly prescribed to help prevent or treat infections during this time, and you are likely to need platelet transfusions to reduce your risk of bleeding. Red blood cell transfusions are given when your haemoglobin levels are too low. During this time you are likely to be experiencing some of the common side effects of chemotherapy and radiotherapy, including nausea and vomiting, mucositis (sore mouth) and bowel problems (diarrhoea).
Once your blood counts start to rise and you are otherwise well enough, you are usually allowed to leave the hospital. In the early weeks after your transplant, you will need to come in to the hospital or clinic regularly so that the doctor can check your blood counts and see how you are progressing.
It can take a few months for your immune system to recover after an autologous transplant so it is important to take some sensible precautions to prevent infections during this time (for example avoid contact with people with an illness like flu or chicken pox).
What are the side effects of an autologous transplant?
Most of the side effects of an autologous transplant are caused by the conditioning therapy used. Although they can be very unpleasant at times it is important to remember that most of them are temporary and reversible.
Conditioning therapies also cause some long-term side-effects. For example high dose treatments can cause fertility problems, affecting your ability to have a baby in the future. In women these treatment’s can also cause an earlier than expected onset of menopause (change of life), even at a young age.
Your doctor will discuss with you all the expected side-effects of your treatment, and the steps that can be taken to help reduce or prevent them.
Does it work?
The success of your transplant will depend on a number of factors including the type and stage of disease you have, your age and your general health.
Important advances have been made in recent years, and continue to be made, improving the success of all types of transplants. Despite this, many people experience a relapse of their original disease at some stage following an autologous transplant. If your disease relapses, there are often ways of getting it back under control. These may include more chemotherapy and/or another transplant, or a drug to stimulate your immune system to fight the disease. Your doctor will advise you on your chances of relapse following an autologous transplant.
It generally takes between three and six months to recover fully after an autologous transplant. During this time it is important to look after yourself and to try to focus on the things you can do to help yourself recover well both physically and emotionally.